Agricultural Knowledge, Science and Technology: Investment and economic returns

The IAASTD is a promising starting point and provides the opportunity for a rational and holistic discussion on the future of agriculture with the cooperation of all stakeholders involved. It presents a clear message: Business as usual is not an option! A thorough and radical overhaul of present international and national agricultural policies is necessary to meet the challenges of the future. The IAASTD does not offer so called “silver bullet“ solutions, in fact it warns us against believing such solutions exist. Instead, it provides a comprehensive and interdisciplinary analysis of the state of agriculture and a wide range of promising approaches.Peer reviewe

Basic science232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function

Background: Cardiovascular disease is a major comorbidity of rheumatoid arthritis (RA) and a leading cause of death. Chronic systemic inflammation involving tumour necrosis factor alpha (TNF) could contribute to endothelial activation and atherogenesis. A number of anti-TNF therapies are in current use for the treatment of RA, including certolizumab pegol (CZP), (Cimzia ®; UCB, Belgium). Anti-TNF therapy has been associated with reduced clinical cardiovascular disease risk and ameliorated vascular function in RA patients. However, the specific effects of TNF inhibitors on endothelial cell function are largely unknown. Our aim was to investigate the mechanisms underpinning CZP effects on TNF-activated human endothelial cells. Methods: Human aortic endothelial cells (HAoECs) were cultured in vitro and exposed to a) TNF alone, b) TNF plus CZP, or c) neither agent. Microarray analysis was used to examine the transcriptional profile of cells treated for 6 hrs and quantitative polymerase chain reaction (qPCR) analysed gene expression at 1, 3, 6 and 24 hrs. NF-κB localization and IκB degradation were investigated using immunocytochemistry, high content analysis and western blotting. Flow cytometry was conducted to detect microparticle release from HAoECs. Results: Transcriptional profiling revealed that while TNF alone had strong effects on endothelial gene expression, TNF and CZP in combination produced a global gene expression pattern similar to untreated control. The two most highly up-regulated genes in response to TNF treatment were adhesion molecules E-selectin and VCAM-1 (q 0.2 compared to control; p > 0.05 compared to TNF alone). The NF-κB pathway was confirmed as a downstream target of TNF-induced HAoEC activation, via nuclear translocation of NF-κB and degradation of IκB, effects which were abolished by treatment with CZP. In addition, flow cytometry detected an increased production of endothelial microparticles in TNF-activated HAoECs, which was prevented by treatment with CZP. Conclusions: We have found at a cellular level that a clinically available TNF inhibitor, CZP reduces the expression of adhesion molecule expression, and prevents TNF-induced activation of the NF-κB pathway. Furthermore, CZP prevents the production of microparticles by activated endothelial cells. This could be central to the prevention of inflammatory environments underlying these conditions and measurement of microparticles has potential as a novel prognostic marker for future cardiovascular events in this patient group. Disclosure statement: Y.A. received a research grant from UCB. I.B. received a research grant from UCB. S.H. received a research grant from UCB. All other authors have declared no conflicts of interes

Conceptualizing Risk and Effectiveness: A Qualitative Study of Women’s and Providers’ Perceptions of Nonsurgical Female Permanent Contraception

Objective: Novel approaches to nonsurgical permanent contraception (NSPC) for women that are low cost and require no incision or hysteroscope/surgical equipment could improve access to, and the acceptability of permanent contraception (PC). To better understand opportunities and limitations for NSPC approaches, we examined women\u27s and OB/GYN providers\u27 perceptions of NSPC in Portland, OR. Study Design: Semi-structured, qualitative interviews were conducted with 40 women recruited from outpatient clinics with purposive sampling, and a focus group was conducted with 9 OB/GYNs in academic and community practice. Transcripts were coded and inductively analyzed with a grounded theory approach. Results: The majority of women identified as white (67%) or Latina (25%). They had a median age of 31.5, and median number of children was one. Perspectives on NSPC were closely aligned with women\u27s general attitudes towards PC; over half were considering PC for themselves or partners in the future. Most respondents valued multiple aspects of a nonsurgical approach, with themes of minimizing recovery time, invasiveness, risk, and avoiding hormonal contraception. Many assumed NSPC would be less effective than surgery, however, and felt a confirmation test would be necessary regardless of the failure rate. Providers welcomed efforts to expand contraceptive choice with NSPC, but would require long-term safety and efficacy data before recommending, and voiced concerns that NSPC\u27s potential relative ease of administration could undermine the inherent seriousness of choosing PC. Conclusions: Women’s and providers’ perceptions of NSPC hinged on the ways in which they conceptualized risk and effectiveness. While perceptions were generally favorable, confirmation of safety and effectiveness would be required for a new approach to be accepted. Implications: This hypothesis-generating study elucidates women’s and provider’s perspectives on new methods of NSPC, and contributes to understanding their perceptions of various types of risk. A technique to verify tubal occlusion would be needed for women and providers to accept NSPC

Interest in Nonsurgical Female Permanent Contraception Among Men in Portland, Oregon and Eastern Maharashtra, India

Objective: We examined the men’s attitudes and perceptions toward the concept of nonsurgical female permanent contraception (NSPC), or novel approaches to permanent contraception (PC) that do not require incisions or surgical equipment/hysteroscope. Study design: Cross-sectional survey of married/partnered men in Portland, OR and rural eastern Maharashtra, India. Descriptive analysis was performed. Results: In India (N=150), most men (80%) anticipated their partners would undergo PC in the future, compared to 30% in Portland (N=170). About a third (39.6% in India, 82% in Portland) reported being uncomfortable with PC for partners due to the need for surgery. Most men (85% in India, 82% in Portland) expressed a preference for a hypothetical new method of female NSPC over surgery, if safe and effective. Conclusion: Most men sampled in two diverse settings expressed interest in NSPC for women. Implications: Men’s perceptions of new female contraceptive methods are important to the contraceptive development process. Men may find a safe and effective nonsurgical method of permanent female contraception more acceptable than surgical PC

Failure after operative repair is higher for ballistic femoral neck fractures than for closed, blunt-injury fractures: a multicenter retrospective cohort study.

INTRODUCTION: The purpose of this study was to describe the outcomes after operative repair of ballistic femoral neck fractures. To better highlight the devastating nature of these injuries, we compared a cohort of ballistic femoral neck fractures to a cohort of young, closed, blunt-injury femoral neck fractures treated with open reduction and internal fixation (ORIF). METHODS: Retrospective chart review identified all patients presenting with ballistic femoral neck fractures treated at three academic trauma centers between January 2016 and December 2021, as well as patients aged ≤50 with closed, blunt-injury femoral neck fractures who received ORIF. The primary outcome was failure of ORIF, which includes the diagnosis of non-union, avascular necrosis, conversion to total hip arthroplasty, and conversion to Girdlestone procedure. Additional outcomes included deep infection, postoperative osteoarthritis, and ambulatory status at last follow-up. RESULTS: Fourteen ballistic femoral neck fractures and 29 closed blunt injury fractures were identified. Of the ballistic fractures, 7 (50%) patients had a minimum of 1-year follow-up or met the failure criteria. Of the closed fractures, 16 (55%) patients had a minimum of 1-year follow-up or met the failure criteria. Median follow-up was 21 months. 58% of patients with ballistic fractures were active tobacco users. Five of 7 (71%) ballistic fractures failed, all of which involved non-union, whereas 8 of 16 (50%) closed fractures failed (p=0.340). No outcomes were significantly different between cohorts. CONCLUSION: Our results demonstrate that ballistic femoral neck fractures are associated with high rates of non-union. Large-scale multicenter studies are necessary to better determine optimal treatment techniques for these fractures. LEVEL OF EVIDENCE: Level III. Retrospective cohort study